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de Boer R et al. Proc SABCS 2010;Abstract P5-11-01.

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ZO-FAST is a randomized study evaluating whether the early use of zoledronic acid versus its later use when patients became osteopenic would help prevent bone mineral density loss in women who were receiving adjuvant letrozole. In this updated analysis, the results were similar to previous reports in that the early use of zoledronic acid is associated with a greater likelihood of maintaining bone density. However, no difference was observed in the incidence of bone fracture between the early and delayed use of zoledronic acid, which is a more important endpoint for most patients. For most clinicians, the standard recommendation is to follow the WHO guidelines for the management of osteoporosis. We screen patients who are receiving aromatase inhibitors, and if the patients become osteopenic or osteoporotic then we institute effective therapy with bisphosphonates.

The ZO-FAST investigators continue to observe a small difference favoring the use of early bisphosphonate therapy in preventing breast cancer events. This observation is part of provocative literature that predated the AZURE trial, the results of which make it difficult to impart much clinical significance to this finding.